The Basic Rule: Age 65 or Certain Disabilities

You become may be able to access for Medicare when you turn 65, regardless of your income or health history. You do not have to be retired. You do not have to be poor. If you are a U.S. citizen or permanent resident who has lived in the country for at least five years, Medicare is available to you at 65.

You can also get Medicare before 65 if you have been receiving Social Security disability benefits for 24 months, or if you have end-stage renal disease (permanent kidney failure requiring dialysis or transplant) or ALS (amyotrophic lateral sclerosis, also called Lou Gehrig's disease). These are the only conditions that override the age requirement.

Key Takeaways

  • You are may be able to access for Medicare at 65 if you are a U.S. citizen or permanent resident who has lived here for at least five years.
  • You can get Medicare before 65 if you have been on Social Security disability for 24 months, or if you have end-stage renal disease or ALS.
  • You do not have to retire or stop working to sign up for Medicare at 65.
  • You should sign up during your initial enrollment period, which starts three months before the month you turn 65 and lasts seven months total.
  • If you miss your initial enrollment period, you may pay a permanent penalty on your premiums unless you have a good reason for the delay.

Work History and Social Security Credits

To get Medicare Part A (hospital insurance) at 65, you or your spouse must have worked and paid Medicare taxes for at least 10 years. This adds up to 40 work credits — you earn one credit for each quarter you pay into the system, up to four per year. If you worked full-time for 10 years, you have enough credits.

If you do not have 40 credits yourself, you may be able to use your spouse's work history if you are married, or your ex-spouse's if you were married for at least 10 years and are now at least 62. If neither you nor a spouse has 40 credits, you can still buy Part A at 65, but the monthly premium will be higher than for people who have the credits.

When Your Coverage Starts

Your Medicare coverage begins on the first day of the month you turn 65. If your birthday is the 15th or later in a month, coverage starts the first of the following month instead. This timing matters because you need to know your exact start date when you sign up.

If you are already getting Social Security when you turn 65, Medicare will be set up automatically and your card will arrive in the mail about three months before your coverage starts. If you are not yet taking Social Security, you must sign up for Medicare yourself through Social Security, Medicare.gov, or your local Social Security office.

The Initial Enrollment Period and Penalties for Late Signup

Your initial enrollment period is a seven-month window: it starts three months before the month you turn 65 and ends three months after. For example, if you turn 65 in June, your period runs from March through September. You should sign up during this window to avoid penalties.

If you do not sign up during your initial period, you will owe a permanent penalty on your Part B and Part D premiums for as long as you have Medicare. The penalty is 10 percent of the Part B premium for each full year you were may be able to access but not signed up. Part D penalties are calculated differently but also last for life. The only way to avoid the penalty is to have had creditable coverage (health insurance that is at least as good as Medicare Part D) during the months you were not signed up.

Special Cases: Still Working at 65

If you are still working at 65 and your employer has 20 or more employees, you may be able to delay signing up for Medicare Part B without a penalty. This is called the working exception. You must be covered by your employer's health plan based on your current work, not on your spouse's work.

If you may have access to for the working exception, you can sign up for Part B later without penalty as long as you sign up within eight months of leaving your job or losing your employer coverage, whichever comes first. You still need to sign up for Part A at 65 even if you use the working exception for Part B. Talk to your employer's benefits office to confirm whether your plan qualifies before you decide to delay.

Citizenship and Residency Requirements

You must be a U.S. citizen or a permanent resident (green card holder) to get Medicare. If you are a permanent resident, you must have lived in the United States for at least five years in a row. Time spent outside the country can break that chain, so if you travel or live abroad for long periods, the five-year clock may restart.

If you are a citizen of another country and do not have a green card, you are not may be able to access for Medicare, even if you have lived and worked in the United States for decades. Some people in this situation may be able to buy into Medicare Part A and Part B, but the rules are complex and the premiums are much higher. Contact Medicare directly to discuss your specific situation.

What to Do Before You Turn 65

About three months before your 65th birthday, gather your documents: your Social Security number, proof of citizenship (passport, birth certificate, or naturalization papers), and proof of residency if you have moved recently. If you are married, have your spouse's Social Security number handy.

You can sign up online at Medicare.gov, by phone at 1-800-MEDICARE, or in person at your local Social Security office. The online process takes about 10 minutes. If you sign up online or by phone, your Medicare card will arrive by mail. If you are already getting Social Security, you do not need to do anything — Medicare will sign you up automatically.

Frequently Asked Questions

Can I get Medicare before 65 if I am not disabled?

No. The only ways to get Medicare before 65 are to have been on Social Security disability for 24 months, to have end-stage renal disease, or to have ALS. If you are not in one of these groups, you must wait until 65. Some people buy private health insurance or use the Affordable Care Act marketplace until then.

What if I worked outside the United States?

Work done outside the U.S. does not count toward the 40 credits you need for Part A. Only work where you paid U.S. Medicare taxes counts. Some countries have agreements with the U.S. that allow work credits to transfer, but this is rare and complex. Contact Social Security to find out whether your foreign work history counts.

Do I have to be a U.S. citizen to get Medicare?

You must be a U.S. citizen or a permanent resident who has lived in the country for at least five years. If you are a permanent resident, the five years must be continuous — extended travel or living abroad can reset the clock. Temporary visa holders and undocumented immigrants are not may be able to access.

What happens if I miss the sign-up important date?

You can still sign up after your initial enrollment period ends, but you will owe a permanent penalty on your premiums unless you had creditable coverage during the time you were not signed up. The penalty lasts for life, so it is important to sign up on time or to confirm you have a valid reason for the delay.

If I am still working, do I have to sign up for Medicare at 65?

You must sign up for Part A at 65. For Part B, you may be able to delay if your employer has 20 or more employees and you are covered by their health plan. You must sign up for Part B within eight months of leaving your job or losing coverage. Talk to your employer's benefits office to confirm your plan qualifies for the working exception.